Open Source Software for Development

Increasingly, Free and Open Source Software (FOSS) solutions are being seen in the developing world as a powerful strategy to leverage the potential of ICTs for supporting local applications and more broadly to contribute to bridging the digital divide. With the rapid spread of internet access, FOSS offers a great potential for significant commercial gains for industries in developing countries, for example, in the domains of saving on licenses for standard business software, for specialized software serving a range of industries, and for contracts to do customizations and to add features. In recognition of the potential that OSS provides to governments with freely available ICT-based tools to address chronic problems of poverty, low productivity, population growth, and epidemics, several countries are now promoting FOSS and setting up international networks (e.g. http://www.nordicos.org/). UNDP has established a network for the Asia-Pacific region . Developing countries are increasingly facing up to the potential of OSS South Africa and Vietnam making important policy decisions, Brazil setting up a 'Chamber for the Implementation of Software Libre.? . BEANISH seeks to develop capacity in Africa to develop, apply, and share OSS.

Open Source Software for the Health Sector

Free and Open Source Software applications are developed for the health care sector in developing countries. The core application is the District Health Information System (DHIS) for the routine collection of data from health facilities. The system?s flexibility allows customization of data elements, indicators and reports to fit the needs of the relevant health authorities, and it is dynamic in order to cater for the integration of emerging diseases, medications and treatments.
The DHIS software offers flexible import/export functionality to allow interfacing with complementary applications, such as for instance patient-based applications (electronic patient records). BEANISH also develops tools for web-based reporting, visualization of health data by using GIS (Geographical Information Systems), a HIV/AIDS management system, and flexible tools to build such applications.

The universe of FOSS projects for health care is expanding. A number of projects relate to the work being done under the BEANISH umbrella. Especially interesting is the OpenMRS project, which aims at user friendly solution for African clinics (and eventually also hospitals). With an initial focus on the scourge of HIV/AIDS and the complexities of following up chronic patients on srictly regulated ARV regimes, the project has now expanded to cater to all kinds of clinical data. This is possible since the architecture and underlying data model is designed around a fully flexible concept dictionary. Recognizing that local definitions and medical practices, including technology, will often vary significantly, the project caters to variety in terms used through the innovative collaborative approach to concepts.

Similarly, complementary FOSS projects are emerging when it comes to laboratory and pharmacy software, both of which are specialized fields, but crucial to the operation of any sizeable clinic or hospital. One pharamacy software is iDart from Cell-Life.  iDart  was developed in conjunction with the Desmond Tutu HIV Centre as a result of a doctor's request for a solution to help manage and monitor ARV drug stock and patient therapy dispensing. Similarly, the open source Bika Laboratory information management system (LIMS) work for general laboratory applications with integrated document content management.

Building Capacity

To achieve sustainability BEANISH emphasizes building local capacity and relies heavily on Master and PhD students, who develops and implements software in collaboration with professional software developers. Initially the development of the DHIS software was centralized to South Africa. Migration to a platform-independent version began as a student project in Oslo and continued with additional support from professional software developers in Vietnam. The India team was the first to deploy the platform-independent version 2 in the spring of 2006, closely followed by Vietnam and Ethiopia. Gradually, domain-specific competence has started to emerge in the partner institutions as different teams worked on different modules and applications, e.g. Geographical Information Systems (GIS), HIV/AIDS module, patient-based systems, etc. Ensuring appropriate collaboration, both strategic and practical, through suitable coordination mechanisms is a challenge that the BEANISH team is currently addressing.

 Building up software teams to support the DHIS 2 in many countries in the south has been a very long and time consuming task - it is hard to find good developers with the requisite experience and interest. The technologies which have been selected for the DHIS 2 software have been relatively sophisticated and modern, and consequently not yet been able to gather a strong following in many countries. Though the Java programming language is well recognized and respected throughout the world, the use of more elaborate frameworks for web development beyond plain Java Server Pages is of newer date, and many developers are most familiar with comparatively simple setups of a few web pages created using a relational database engine  as backend and PHP, ASP or JSP as the frontend. This is also what is mostly taught in various institutions of higher learning as well as more vocational training programmes. This approach is however not viable for large, complex applications such as the DHIS 2, especially since it is being developed as part of a world wide collaborative network. A web framework such as Struts has gained some recognition among certain sectors of the developer community in Africa, but the lesser known framworks such as Webwork remain relatively obscure.

 Fortunately, over the course of the BEANISH project, we have been able to establish a network of developers of minimal critical mass, so that they are able to support each other. Most developers do some travelling in the network, so that most of them will have met each other, and have at least worked closely with the core developers for several days. This breaks down the barriers to contacts once problems arise (as they are wont to do). Likewise, prolonged insistence on practices such as regularly checking code into the global repository (with accompanying comments), the creation of unit tests and the documentation of code has steadily improved over the last two years. There are in fact currently about 8 active developers spread over several countries. Traffic on the developers list has also stablilized and seems to function for most issues. The introduction of simple issue tracking software has also improved the coordination of the software development, though it still is overwhelmingly used by developers and coordinators based in Oslo.

South-South-North Collaboration

The BEANISH partners are institutions in six African and two European countries. To achieve sustainability over time, BEANISH works at building local capacity. A joint Master?s program, as well as a number of PhD students enrolled at the University of Oslo offers a multi-national cohort of students, who will receive a broader picture of challenges and opportunities, as well as the possibility to conduct comparative cross-country studies.
The aim of BEANISH is to share e.g. best/worst practices and implementation experiences, on data use and analysis, as well as to enable technological competence to flourish. Challenges exist in achieving these things in an optimal way. For the software development team, an electronic forum (with software repository, bug and issue tracker, discussions forum and mailing lists) serve as the daily coordination tool. However, several partners experience low connectivity and need to utilize more lightweight forms of communication, e.g. chat and SMS.
For strategic decision-making and for implementation support we have learnt that circulation of key resource people in the network is necessary. Technological competence associated with particular application areas or technologies have been transmitted through intensive co-located collaboration among a visitor and the local team over typically 4-8 weeks. Other forms of internal dissemination activities are workshops and seminars.

Research Focus

Despite policy pronouncements from governments on the use of OSS, little knowledge exists on how these technologies are actually taken up in developing countries. Best practices, tools and strategies for OSS development in South-South-North development teams need to be developed based on real-world experience. These are some of the research topics studied by the BEANISH R&D project through a concrete real-life project.

The District Health Information System

The core application is the District Health Information System, which is available in two recent versions (in addition version 1.3 is still in use).

DHIS 1.4

Version 1.4 is based on Microsoft Access database. DHIS 1.4 provides users the possibility to define different dataset and to enter data in any level of organization hierarchy. The users can flexibly define data entry forms to fit with the relevant local needs and standards, and similarly the report format can be customized. DHIS 1.4 supports Excel pivot tables and provides health managers a powerful tool for flexible analysis. The indicator engine provides users the tool to convert their data to Information which is needed for decision making. This version is currently under customization and pilot use in Botswana, Malawi, Mozambique, Ethiopia and Vietnam. Multilanguage functionality is available in the software, which currently exist in English, Portuguese, Vietnamese and Kiswahili.

DHIS 2.0

The DHIS 2.0 is a platform-independent, web based and based completely on open source components. It has a modular structure, where new modules and plug-ins can be added in. Currently development is ongoing of providing functionality on several analytical modules enabling use of graphs and charts. DHIS 2.0 is currently piloted in several places in India, Sierra Leone, Tajikistan and Vietnam, and has multi-language functionality (full or partial translations exist to English, Tajiki, Gujarati, Russian, Malayalam, Hindi, and Vietnamese, Burmese, Norwegian and more). There are also immediate plans to extend the funcitionality to cater to right-to-left languages such as Arabic and Hebrew. Analysis Module: This module bring the users the ability of visualization of health data. A web-based pivot table is useful also for non-routine, ad hoc reports. Also the possibility to produce charts and graphs are developed. The module?s functionality for utilizing GIS for spatial analysis of health data is relevant for health managers who need information for decision-making

Where can I get the software?

Go to www.hisp.info: The software and information is available on the website. The discussion forums and mailing list archives may also contain useful information.